Theme 1: Experience at the work level
The difficulty of nursing operation implementation
In order to ensure the safety of medical staff and reduce the risk of infection, nurses were required to wear heavy protective clothing and multiple layers of gloves in order to enter the ward to complete required tasks (such as intravenous injection, intramuscular injection, and arterial blood collection), which to some extent increases the difficulty of carrying out nursing operations. P02: “In order to be safe, our protective equipment consists of many layers and is airtight. When the weather is relatively cold, the protective mirror easily fogs, which will have a great impact on our infusions and injections.” P03: “We always wore light clothing when we performed our daily work. Now we wear heavy protective clothing and we need to wear multiple layers of gloves. If we cannot find the correct position when we perform infusions or arterial blood collection, it is very inconvenient for us to treat patients.”
A sense of accomplishment in nursing work
Although there are multiple difficulties in entering clinical front-line work, nurses rise to the occasion with their innovative thinking, which not only results in patients receiving more optimal nursing treatment, but also increases the safety and ease of use of nurses’ own protective equipment. P07: “We used to wear a suit of overalls with feet. There was a long strip on the collar of the overalls. It would bounce to the face when we took off the overalls.” P15: “When we wear protective clothing, sometimes there will be skin indentations. We use glued-on sponges or other applications to protect us and reduce the damage to our facial skin.”
Theme 2: Experience at the physical level
Fatigue
Front-line nurses undertake intensive nursing tasks, not only to complete specialized treatment and nursing, but also to perform tedious basic nursing, such as disinfection and isolation work. Especially in the treatment of severely ill patients, due to the severe respiratory symptoms of COVID-19 and the rapidity with which changes in the patient’s condition can occur, nurses need to exercise caution. Numerous factors result in a heavy workload for the nursing staff, and physical exhaustion can result. P06: “After working for more than 10 days, our bodies are more or less tired, such as arms and legs, and muscles are sore.” P17: “Because the patient’s condition is unstable, nurses will often work overtime due to special circumstances, and the body will not get timely rest, which will aggravate fatigue and increase tiredness.”
Injury and discomfort
To avoid cross-infection, medical staff wear protective clothing, isolation clothing, goggles, and masks while treating COVID-19 patients. However, wearing goggles and masks for too long will cause pressure injury to facial skin. Wearing protective clothing also causes oxygen deprivation, overheating, and inconvenience in using the toilet due to air tightness. P01: “We need to wear N95 masks at work, which cause indentations on the bridge of the nose and the skin of the face. After a long time, the skin will become red, and the mask will leave marks.” P05: “At work, the body needs to withstand some pressure from protective gear, such as indentations caused by a face mask. My skin is relatively sensitive, and wearing protection results in feeling hot and the subsequent development of eczema, which causes great discomfort and affects my mood at work.”
Theme 3: Psychological experience
Enormous psychological pressure
Because COVID-19 is highly infectious and the population is generally susceptible to it, there is a higher probability for nurses to become infected because they need to be in close contact with patients during treatment. At the same time, because the first-line nurses are away from their families and their family roles are weakened, they experience much worry and miss their family members. In addition, a nurse’s inability to cope with the severe condition of the critically ill patients produces negative emotions. Therefore, nurses need to bear huge psychological pressures that originate from themselves, their families, and their patients. P04: “The main aspect of my life is that I cannot go home after the outbreak. Sometimes I miss my family very much, and I worry about them, such as whether there are protective materials for them, such as masks. I also worry about myself.” P11: “We come into contact with many severely ill patients, including patients requiring endotracheal intubation. Many times, we felt that we were unable to treat them, and when this occurred, we felt very sad.” P18: “When we first entered the clinical line, we all felt very nervous and afraid. My parents have only one child, so what would they do if I got infected? Besides, I often stayed with my teammates.”
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) refers to a mental disorder caused by sudden, catastrophic, or threatening life events that cause individuals to feel continuous stress even after the threat no longer exists (Chuan et al,2020). Because of the particularity and urgency of the work, first-line nurses often manifest acute traumatic stress disorder, and often exhibit psychological symptoms of insomnia. P08: “When I was interviewed, I was still a little afraid. I did not sleep well at night, and all I dreamed about was the epidemic situation.” P11: “I suffer from insomnia, and when I go to work, my body clock is out of order. Sometimes I cannot sleep and I have nightmares.”
Sense of mission or accomplishment
The nurses who went to the front line of the epidemic were confident that the war would be won. They assume the responsibility to go to the front line to treat patients, and have the sense of mission to never retreat in the face of the epidemic, and take the patient’s recovery, cure, and discharge as their own achievement. P10: “When we saw a lot of patients getting better and being discharged from the hospital, I think we saw hope, which is also equivalent to a sense of accomplishment. Many patients wrote thank-you letters to us, or created banners, etc., and we found a sense of accomplishment and the meaning of saving people.” P12: “I took care of a patient who was discharged directly from the intensive care unit within 7 days, and now the disease has not returned. He wrote me a thank-you letter, and thanked me for his care. When he said ‘thank you for saving my life,’ I was extremely moved by his heartfelt gratitude.” P14: “It is very necessary that we, as medical workers, should contribute our own efforts, respond to the call of the country, and do our best.”
Theme 4: Experience of TCM nursing
Frustration during treatment
Chinese medicine nursing embraces the holistic view of TCM as the guiding ideology of nursing work, and always attaches importance to nursing, advocating “three points of treatment, and seven points of nursing.” Therefore, in accordance with the requirements of TCM, nursing should adopt a more rigorous and serious attitude to treatment. However, because of the fierce outbreak of COVID-19 and the erection of temporary wards, the implementation of TCM nursing resulted in many difficulties. P09: “Our doctors need to look, smell, ask, and cut before prescribing TCM prescriptions to patients. However, in order to protect them, we need to touch the pulse with three layers of gloves, which is then difficult to accurately identify in many cases.” P10: “The difficulty I encountered was how to implement the TCM program in the intensive care unit. COVID-19 is an infectious disease, and many severely ill patients could not live without oxygen. Therefore, TCM therapy such as baduanjin and a medicinal bath cannot be adequately carried out.” P13: “One of the most difficult aspects of TCM practice is the evaluation of its efficacy. TCM requires continuous observation and nursing. However, due to our overloaded schedule and an excess of work, I cannot carry out continuous nursing for patients, which will diminish the overall effect of TCM nursing.”
The joy after treatment
More than 20 types of commonly used TCM techniques, such as acupuncture, moxibustion, cupping, massage, scraping, fumigation, and washing, are simple and effective, and they greatly enrich the content of TCM nursing. The use of traditional Chinese medicine technology by the nursing staff can be very beneficial to relieve pain and improve the disease condition in patients. P10: “Because many patients had insomnia at that time, I adopted the method of acupoint massage to help them. I mainly chose the yongquan, shenmen, and neiguan points of the patients for massage to promote sleep, which was very effective.” P16: “We applied some TCM special nursing, such as qigong baduanjin, TCM health exercises, five elements music therapy, moxibustion, foot baths, and the ear sticking point, which can help patients, especially for gastrointestinal reactions, insomnia, and other symptoms. Patient compliance is very good, and we are very satisfied with the treatment effect.”